快速流程在结肠癌围术期管理中的应用价值

摘要

目的:探讨快速流程(FT)模式在结肠癌围术期管理中的应用价值.方法:收集按照FT模式管理的47例(FT组)和传统模式管理的80例(传统组)结肠癌患者的临床资料,对其进行对照分析.结果:早期康复方面,FT组首次排气时间和术后住院时间均短于传统组(均P＜0.01);对于FT环节完成情况,FT组均采用限制补液策略,而传统组均未采用,差异有统计学意义(P＜0.05);早期经口进食和不常规安置引流管的完成情况,FT组均明显高于传统组(P＜0.05);两组早期下床活动、早期拔除胃管和早期拔除尿管的完成情况相似(P＞0.05);术后并发症方面,两组患者术后并发症如肠梗阻、尿潴留、吻合口漏、腹腔感染、肺部感染和精神症状的发生率及总发生情况方面的差异均没有统计学意义(P＞0.05).结论:结肠癌手术患者采用FT模式管理能促进早期肠功能恢复,缩短住院时间;其更好的应用尚需要做好本土化工作.%Objective: To evaluate the application of fast-track surgery for the perioperative management of colonic cancer resection. Methods: From October 2008 to May 2010,47 patients treated with fast-track surgery were analyzed retrospectively, who were compared with 80 patients treated with traditional method. Postoperative recovery index and completion rate of FT items were studied and compared. Results: In early rehabilitation, patients in FT group recovered bowl movement significantly earlier than those in the traditional group( P ＜ 0.05 ). Postoperative hospital stay was also shorter in FT group( P ＜ 0.05 ). All patients in FT group restricted rehydration while no patient in traditional group did. The rates of early oral intake were higher and less routine use of drainage in FT group ( P ＜ 0.05 ). However, there was no significant difference in early ambulating, early removal of nasogastric tube and urinary catheter between the two groups. Neither was there significant difference of complications between the two groups. Conclusion: Fast-track surgery for the perioperative management of colonic cancer could accelerate return of bowel movement and shorten postoperative hospital stay. Customization is needed to make a better application of fast- track surgery.